ENT. Bronchoscope»Hemer«

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1 ENT Bronchoscope»Hemer«Sampling channel for pressure and tidal gas measurement Multiple lateral slits for improved ventilation Connector for jet ventilator ISO standard cone for conventional ventilation systems Length markers

2 Bronchoscope»Hemer«* The new rigid bronchoscope for interventional applications Procedures in surgical bronchology such as transbronchial fine needle biopsy, recanalisation with laser resection or argon plasma coagulation, dilatation, stent placement or cryotherapy are relative or absolute indications for rigid bronchoscopy. JET ventilation, ideally under general, intravenous anaesthesia allows free access to the bronchial system using the rigid bronchoscope. While the oxygenation of the patient under JET ventilation can be monitored with pulsoxymetry, methods of capnography and tidal gas analysis as well as methods for measuring pressure are not clinically established. If expiration is obstructed, the JET pressure brings with it the risk of barotrauma. To avoid endobronchial burns during argon plasma coagulation or laser resection, the inspiratory oxygen concentration must be reduced to such an extent that the oxygen concentration on expiration is Our aim was to develop a new rigid bronchoscope that would avoid the risks of barotrauma, hypo- or hyperventilation and endobronchial burns. The pressure on inspiration resulting from the JET nozzle and entrainment reaches a plateau in the working channel at a distance of more than 10 cm from the instrument opening which can be measured without any significant change in pressure as far as the patient opening and subsequent bronchial system. As a result, it is possible to measure the inspiratory pressure at one point along the plateau which can be taken as being representative of the inspiratory pressure. To measure the pressure, the lumen of the working channel is connected to a sampling channel at a distance of 14 cm from the instrument opening. Using the sampling channel, the pressure on inspiration and expiration, the oxygen concentration on inspiration and expiration and the carbon dioxide concentration in the tidal gas can be measured at the same time. The automatic shutdown of the JET ventilators if the pressure is exceeded was successful in trials and allows pressure-controlled JET ventilation. For gas analysis, JET frequencies below 18/min should be selected. Pressure measurement and automatic shutdown of JET ventilators when the pressure is exceeded also functions during high frequency operation. The measuring devices for pressure and breath gas and the JET pressure control are connected via commercially available 3-way taps and connecting tubes to the Luer connector of the sampling channel. The new rigid bronchoscope with sampling channel for pressure and tidal gas measurement and the proximal illumination insert is constructed of thin-walled stainless steel making the instrument light and convenient to use. The side slits are aligned in three rows with the emphasis towards the distal end to improve ventilation. The JET nozzle is secured firmly in the JET connector with a bayonet lock. The JET connector has an outer cone complying with the ISO standard so that conventional breathing systems can be connected. With this new rigid bronchoscope with sampling channel for pressure and tidal gas, JET ventilation can be performed with the same quality and same safety level as conventional ventilation. The tidal gas analysis allows the oxygen concentration to be controlled and CO 2 -controlled narcosis avoids hypoventilation. The bronchoscopist has a convenient instrument with a free lumen in various sizes allowing a suitable size bronchoscope and instrument set to be used. Literature: Pobloth, A. et al. "Ein neues starres Bronchoskop mit Messröhre für Druck und Kapnometrie" Pneumologie 2001; 55: Reichle, G. et al.: "Argonplasmakoagulation in der Bronchologie" Pneumologie 2000; 54: *Lungenklinik Hemer, Theo-Funccius-Str. 1, D Hemer The bronchoscope»hemer«was developed with the cooperation of Dr. med. Alfred Pobloth and Dr. med. Günther Reichle. Improved ventilation due to geometrically optimised ventilation slits New atraumatic shape of the distal sheath tip 2

3 Proximal illumination insert Luer connector to connect the sampling channel and monitoring units Lateral respiration connector Jet ventilation nozzle with bayonet connector for fast and safe locking to the bronchoscope ISO standard cone for connecting conventional ventilation systems Sampling channel for measuring carbon dioxide, oxygen and airway pressure Fully free inner volume with smooth inner surfaces - without disturbing corners and edges 4

4 Ventilation and Monitoring ENT with the new rigid bronchoscope»hemer«ventilation Jet ventilation unit with FiO 2 setting Optimum ventilation + O 2 laser and APC application reduction for Jet ventilation unit with pressure cutoff Optimum ventilation + avoidance of barotrauma Monitoring... Gas analysis Optimum ventilation by measuring expired CO 2 and control of FiO 2 Pulsoxymetry Avoidance of hypoxaemia Pressure measurement Pressure measurement to avoid trauma and for pressure-controlled jet ventilation Jet ventilation with optimised monitoring... for greater patient safety 5

5 ENT Bronchoscope»Hemer«Bronchoscope Tubes OL WL Bronchoscope Tubes Inner ø WL OL Type Particularly suitable for interventional bronchoscopy. 6 x mm mm 400 mm 7 x mm x mm x mm 385 mm 430 mm x mm x mm 305 mm 350 mm "Excavator" Biopsy Forceps by Reichle WL Standard biopsy forceps Excavator XL Excavator XXL H H W W The "Excavators" are particularly suitable for removing large portions of tissue and can also be used in conjunction with laser resection or argon plasma coagulation (APC). Excavator XL Excavator XXL WL 474 mm 483 mm W x H 9 x 9 mm 12 x 9 mm Suitable Tubes Type Required telescope:

6 Bronchoscope»Hemerworldwide«your partner in Endoscopy and ESWL Accessories ( ) Telescope adapter Suitable Tubes Matching Telescope Type Printed on paper based on cellulose which has been bleached without the use of chlorine The telescope adapter guarantees a safe connection between the telescope and bronchoscope tube. It prevents the telescope slipping accidentally Nozzle for jet ventilation (only for bronchoscope 8214.xxx) incl.: Luer connector ( ) Sealing cap with telescope sealing cap for telescopes ø 5.5 mm ø 4 mm, 3.4 mm and 2.7 mm Adjustable telescope magnifier also: Sealing cap with monitoring window (with outer cone, blue) Universal sealing cap by Lehnhardt incl. 2 telescope sealing caps (89.01, 89.03) Spare telescope sealing caps (pack of 10) for telescopes Ø 5.5 mm Ø 4 mm Ø 3.4 mm and 2.7 mm Proximal illumination insert Stopper Sealing cap LUER sealing cap Cold light connector ACM Storz Technical specifications subject to change without notice. RICHARD WOLF GmbH Knittlingen PF 1164 Phone Fax GERMANY info@richard-wolf.com AUSTRIA: RICHARD WOLF Austria Ges.m.b.H. Wilhelminenstraße 93 a A-1160 Wien Tel.: Fax: info@richard-wolf.at BELGIUM: N.V. Endoscopie RICHARD WOLF Belgium S.A. Industriezone Drongen, Landegemstraat 6 B-9031 Gent-Drongen Tel.: Fax: endoscopy@richard-wolf.be FRANCE: RICHARD WOLF France S.A.R.L. Rue Daniel Berger Z.A.C. La Neuvillette F Reims Tél.: Fax: endoscopes@richardwolf.fr UK: RICHARD WOLF UK Ltd Waterside Way Wimbledon SW17 0HB Tel.: Fax: admin@richardwolf.uk.com USA: RICHARD WOLF Medical Instruments Corp. 353 Corporate Woods Parkway Vernon Hills, Illinois Tel.: Fax: sales&marketing@richardwolfusa.com G 639.II.03.GB.1